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Tuesday, January 24, 2012

A Transport.

Last night, Judo, a 22 year primigravida was carried into the clinic by her family. Exhausted she fluttered in and out of sleep as I checked her vitals.

She is from the Luo tribe; and since no one else in her family could speak any Dinka, she pushed past her fatigue to explain her long and difficult labor herself.

Her contractions had started two days before. Everything looked good until her water broke and she started pushing. She pushed and pushed for over six hours, but her baby would not come. Eventually her contractions just faded away.

She had not had a contraction since dawn --roughly 16 hours earlier.

Gesturing toward the wrinkled woman at the foot of her bed, she explained “My grandmother was my midwife. She said she could see the baby’s head, but it went back inside.”

I looked back and forth from her grandmother’s worried face to her oblong belly while trying to process her words.

What? She was in labor? She didn’t look like she was in labor. Could they have been mistaken? Perhaps she had malaria-labor and just dreamed up the fact the head was poking out? --Doubtful.

I needed more facts.

A quick vaginal exam explained everything. Not only was she fully dilated, but the presenting parts were at a +2 station. Her pelvic outlet seemed adequate despite her low pubic arch, but the real problem was the swelling.

It took me a long, breathless minute before I realized the squishy mass of swollen flesh was her baby’s head. It was so edematous I could not find any suture lines. None at all.

Not good.

All the signs pointed to deep transverse arrest due to cephalopelvic disproportion (or CPD).

She needed a cesarean.

The good news was an American surgeon just came on staff last week. The bad news was we are not ready to start doing cesareans yet.

After discussing her case with the rest of the staff, we decided to transport her to Wau instead of risking an ill prepared surgery.

When we explained the situation to her family, they didn’t hesitate. They quickly gathered the necessary funds and an hour later she was en route.

I’m happy to say that this was the fastest transport we have ever organized. Originally when I heard that she’d be transported, I assumed we’d have to wait until sun up like before. But I was wrong. Apparently, we have a new driver who can go at all hours of the day and night.

What a blessing!

Today I am genuinely grateful for cesareans, ambulances, and willing drivers. By now, Judo and her baby should be recovering from surgery. Pray that it was successful and that they heal quickly. Thanks.

And also pray for our new surgeon and the many families he will bless in the coming months. I’m told that he is doing a hernia repair today. Exciting!